Managed Care Contract & Consulting Services

○ Contracts in place
○ Managed Care system in place
○ Facility – effective                                  communication for teamwork
○ Health plans have a job to do
○ Health plan needs

○ Educate staff
○ Prepare/train team
○ Understand philosophy change
○ Market, market, market
○ Communication with vendors,         doctors, those servicing SNF

BEWARE vs BE AWARE


   1. Resistance to change of philosophy and pace
   2. Decentralized case management – Things fall through the cracks that almost always result in revenue loss
   3. What the health plan wants
   4. The health plan has a job to do
   5. Cash Flow & Reimbursement
   6. A contract can only be great if it is used to its maximum potential


○ Medicare – All eggs in ONE                    basket
○ Contracts ?
○ Lacks current information
○ Complexities of managing                 ○ Skilled/Custodial stay of HMO              beneficiary

○ What change means?
    ○ Billing: long-term and                  short-term
    ○ Length of stay
    ○ Authorizations
    ○ Updates
    ○ Communication
    ○ Initial Evaluations
    ○ Facility Team

"PREPARED"

SNF

  "UNPREPARED"

SNF

Preparing for Managed Care

  • Who to bill?
  • When to bill?
  • How to appeal?

4.  Does your staff know how often to communicate with the health plans and when to inform the plan that patients'               level of care has changed?

5.  Does your facility check eligibility and benefits upon admission and on a weekly basis?  This is a MUST DO in                      many states where managed care initiatives have begun.

6.  Are you getting full revenue reimbursement on all contracts? 

7.  Do you have a specialist to answer your managed care questions? 

Owners

Operators

Administrators

Business Office Managers

If you answered “No” to any of the above questions, Mix Solutions can help!

With managed care shrinking our profits, mastering managed care is IMPERATIVE.  ​


   MANAGED CARE STATUS CHECK:

  1. The dates for managed care initiatives are coming up fast or, worse yet, are already here.  Do you have the initiative information?  Do you know the managed care health plans that won the contracting awards?  Have you informed your facility change is coming?
  2. Are your managed care contracts current and negotiated with the best terms and rates possible? 
  3. Do you understand the billing process with each MCO? 







Take this dose of reality "Q & A" to see where you stand with managed care. 

Is This You?

Are You a Healthcare Provider Wondering How to Work with Managed Care?